Being human Archives - Page 46 of 50 - Man, Medicine, and Mike

Our Lives as Well Written Novels

”While they were there, the time came for the baby to be born, and she gave birth to her firstborn, a son. She wrapped him in cloths and placed him in a manger, because there was no guest room available for them.”

In this Christmas holiday season we often read or hear read the story of the nativity. It is a grand and humble story. It warms our hearts. In this season of the nativity, I hope you will enjoy a reflection on my thinking on life.

As is usual in this blog, I honestly and openly reflect my thinking. Not everyone will agree with me. That is ok. But there is richness in the dialogue and how we all can learn from each other. These are the thoughts that fill my heart and mind this holiday season.

I enjoy a good novel.

In it there are of course some important elements. The characters and how they are developed is very important. They can’t be one dimensional. They must have some complexity. The narrative must flow well.

But above all there must be a plot. The plot cannot be too obvious. It has to develop and flow over time. It weaves in and out of the characters lives and we go on a journey of discovery as we read. If it is too obvious we will lose interest in the book. If there is no plot we end up wholly unsatisfied. But the masterful book is one in which we wonder what is going on. We are eager to find some purpose or meaning and how things can or might tie in.

The most excellent novels have elements that you see but perhaps don’t even really notice and then later they tie in with remarkable and profound meaning. They hit you and you are suddenly amazed at their significance. It all starts folding together and it makes sense. The pages that have gone before this point become cherished friends. You love them and are so glad you got to know them because now you know how important and how significant they were to what was really going on the whole time.

I like to think my life has been a great novel. It thrills me to see events that at the time didn’t seem to mean a lot and how they have come back years later to be of profound significance. There were thrilling times. There were slower times that were spent on developing the main character in the novel. But now I see how important those times were and even the mundane parts of the story now jump out as being ever so important.

Why does this matter?

What is reality? Are our lives meaningful? Are they the product of a skilled author who profoundly knows in advance what elements must be weaved in and out of our lives? Is our story being created for us? Will we be able to look back and read through it and appreciate it? Will we even love some of the passages for how profound they may seem in retrospect?

Or are our lives just happenstance? Do we stumble along doing the best that we can as we scribble on the pad of paper kind of inventing things as we go? Is it like the game where each person adds a line onto the story as we go around the room. These stories can be funny as each person goes up and down different tangents. But these stories are not elegant. They usually leave you unsatisfied. They are like a sweet that you munch on. It may taste good for awhile but doesn’t really leave you satisfied. They are not the full meal with all of its content that leaves you satisfied and happy at the end.

I have strong beliefs in this regard. There is no question in my mind which is reality.

I have seen it played out already. The story has been well written so far. It has so much more depth to the story than I would have added if I had written it myself. I think I would have written an obvious story without the subtleties that I now see and appreciate. I probably would have left out some things unless it made me look better or more dramatic. But mostly – I just would have written a much more dry and direct story.

The beginnings were humble. The plotline took time to develop. The first portion spent a lot of time developing the many characters and personalities. There were a lot of mundane details that I didn’t really appreciate at the time. But now I see how much color and realism and depth they added to the story. In retrospect I wouldn’t change them. I also love to go back and reread some of the parts. Some of the parts are painful. I reread them because I need to. They are important. Some are fun or funny. I tend to skip over some of the more embarrassing parts. I probably would love to cut those pages out but the author felt that they were necessary.

What am I trying to say?

There is purpose and meaning to all of our lives. It is startling and amazing and beautiful. It is more than what you could even imagine. I honestly believe that one of the joys of heaven will be to look back and see the incredible meaning behind it all. Like the sweet taste when you read the last page of a treasured book will be the joy of realizing that God was in charge the entire time. In spite of the difficult or stubborn characters in the book He was able to carry through an amazing story and weave it all together.

God is there. He is the author. He dreamed up who you would be, was there when you were conceived and was there as you grew in your mother’s womb. Your birth was not a surprise to Him. He has loved you before you could even know what love was. He was watching and cheering for you when you made good choices and perhaps wincing a bit as you made bad choices. He was pulling things together and calling to you with the goal that you would come to Him so that He could heal you and perfect you. You are His creation. You were made by Him and for Him and so that you could enjoy Him and He could enjoy you.

“God loves you and has a wonderful plan for your life.” This is one of the 4 spiritual laws that were popular in the 70s. It was an appeal to help people realize that He is a loving and personal God.

Please do not misunderstand. The story that He is writing for your – or His “wonderful plan” – is not a simple one. It is not a perfect plan because you and the whole world are part of a fallen creation. It is part tragedy. It is drama. There is comedy at times also. It is mostly a redemptive story. Oh – and by the way – you are NOT the protagonist. You are really not even the main character. Truth be told – if you had the ability to read and grasp the entire novel – you would see that you are but one character in a much grander redemptive story that pulls multiple elements together with the ultimate goal of declaring the glory of God.

It is not health and wealth. While the story may have moments of beauty there are a lot of times that it is not pretty. As in most profound novels there are parts of it that are truly painful and tragic. We cannot nor should we trivialize or try to neatly explain those away. The story is gritty and real. It has deep flaws in many of the characters and fractures in many of the events. Parts that could be just perfect are fractured or flawed by the fallen circumstances and characters that make up that chapter. The glory and the beauty comes in how the protagonist – both as the narrator and author – but also as one of the characters in the story – pulls it all together throughout the story and in the end.

God is there.
He created you.
He knows you and loves you.
You are fallen and flawed.
But God is much greater and amazingly He can pull you just as you are through a story – a redemptive story – and bring you to Him. There He can perfect you. And someday – we can sit before Him and in great wonder and love hear the author explain it all so clearly that our hearts will overflow.

That is the world.
It is God’s world.
Please, please, please – don’t miss seeing it!
It happens to be one of my favorite books and I deeply hope you can appreciate it with me.

Can you indeed speculate and dream with me for a moment?

Can you think that your life may indeed be a well written novel? What might have to now looked like scribbles or fragmented story lines, might actually be intricately woven together soon to make wonderful and logical sense. It is not a perfect story. Any good novel does not have perfect characters and perfect actions. There are always twists and turns.

But, as a child on Christmas Eve, can you engage in wonder in the thought that there might indeed be an author for the story that is your life? Can you let the Christmas lights reflect off of your rosy cheeks and glisten in your eyes. Could you look for the author and the story that He is writing as you turn the next pages of your life into the coming year?

On Becoming a Patient

My first overnight in the hospital as a patient!

Brenda had an acute appendicitis. She was suddenly very ill and had surgery and ended up in the hospital. I am sure it was no fun. But I envied her.

I was a 3^rdyear medical student and felt very tired and very stressed. It was before the concept of work hour restrictions. Call was truly overnight and all night. There were no medical student call rooms. The post call day was not easier or an early day. It was harder because you had to present and defend your care of the admissions from the prior night. I was learning a lot. But I was tired.

I envied Brenda. She was lying in a bed and reading or watching television. I dreamed of what it might be like to have people bring me food and drink and to just be able to click through the channels on the television.

Oddly this pattern has continued throughout my medical practice. Rounding on the day of the “big game” I wander in and out of patient rooms. The game will be on the television and I am tempted to look but I have just a few too many patients to see. I push on. I listen to the patient. I listen to their heart and lungs. And then I move on.

Sometimes it is the show, “Gunsmoke.” I loved that show as a child. I even wrote to James Arness for an autographed photo. I used to keep it in a certain drawer in my parent’s desk at home. One year I got a full outfit complete with a plastic gun with plastic bullets and holster. I haven’t watched that show for years but one day I saw it on television in a patient’s room. I envied him.

Gunsmoke - The Directors Collection — https://www.amazon.com/Gunsmoke-Directors-Collection-James-Arness/dp/B000H7JCHI

Once again however I pushed ahead. I asked my standard questions of them (enough to at least bill a level 2 rounding note). I looked at their neck veins, listened to their heart and lungs and felt their ankles. And on I went.

Sometimes it is “Fixer-Upper.” I watch this show at home. For those of you who are fans, my wife, daughters, and I have been to Magnolia and to Magnolia Table in Waco! And no, we have not met Chip and Joanna. But when it is on while I am working, it oddly feels like it would be such a luxury to stop during the work day and just watch it.

Image result for Fixer upper magnolia — https://i.ytimg.com/vi/zbebsu3rCoc/maxresdefault.jpg

And then I got sick. And for the first time in my life a bunch of things flipped:

I became a patient rather than the physician.
I was suddenly taking a lot of pills
I was off work with a lot of time available to me.

And so today I write as a voice of someone who has “crossed over” to the other side of being a patient. I do not know that I will be particularly eloquent or poignant, but it is a different perspective. I am hoping to share just a few impressions here. Perhaps others who have experienced the other side will want to add some more in the comments later?

Phase 1: Post-op:

I was very sore. I couldn’t move around without clear intentional action. To get up and out of a chair was something that was planned and then executed. Walks (a lap around my living room) were planned and carefully performed.
I was able to read and watch a lot of television. I watched, “Gunsmoke”. I realized that it is kind of a depressing and sad show! There are a lot of sad things that happened to make the drama for the show. I watched some movies. I watched recommendations from friends and coworkers.
My body was not intended to sit or lay down a lot. My neck and back would get sore. I would get headaches as a result. I tested and used every chair and sofa in my house trying to find the best position to sit or lay. My daughter taught me the joy of a hot shower. (I now understand and have compassion for our LVAD patients who are not yet allowed to shower!)
I walked very slowly. My wife laughs when she tells about my first walk at the hospital. I kept asking her to slow down. I think she felt that if she slowed down any further, we would be walking backwards!
Rolling over in bed was a job. I never imagined this with all the patients that I have managed through surgery. I had to think very intentionally about rolling over and whether that was good or bad.
Electrical jolts. These were a very unwelcome surprise. I have tried to look up the anatomy and realize that nerves are never quite as logical as I think they should be. If I tried to slide toward my left and roll a bit to hug my wife, I would feel a sudden and severe hot knife stab to the left groin. Wow! Ok. So, I guess I had better not do that. The good news is that those have now passed.
“You just wiggled your finger! That’s wonderful!” “I’ve always been a fast healer.” For those that don’t recognize those lines they are classics from the movie, “The Princess Bride.” As I recovered one day Sarah made this pronouncement. We laughed a lot at that one and those lines have become a hallmark of my recovery process.

Phase 2: Radiation and Chemo:

Fatigue more than drowsiness. I may post this as a full blog post later. But I have learned that sometimes sleep is needed more than desired.
Queasy and nausea: My thanks to Karen W for suggestions and advice on how to handle this. My profound thanks to the pharmaceutical industry and the combination of Zofran and Compazine! I think about all of the patients for whom I have prescribed mycophenolate who have then struggled to manage the nausea. Sorry!
Obsession with bowels: Not going to get into much detail here save it to say that I feel like an old man especially when shopping down the bowel regimen aisle at Meijer. It is embarrassing to be jostling for position next to the 80-year olds who are also shopping there!
Oddly – too tired to read – but not too tired to write. I don’t understand this but maybe it is some glitch of my own creative mind being deprived of work? I am sure that it will pass but for an avid reader it is a bizarre part of this phase.
Home blood pressure checks: Seems that it would be easy to just do this regularly right? I bought a home BP cuff but frankly I am pretty bad at doing it. I seem to grab it when I am obsessing about my BP but then mostly ignore it!
Learning to swallow a lot of pills: I had become a bit proud of my ability to swallow an occasional naproxen or Tylenol. Now I marvel at home many pills I take! When I lay them all out, I want to take a picture of them (I have done this!) It just amazes me all the things that I am putting into my body! But I also found that it became harder to swallow so many. Big tablets are the worst. I used applesauce and it started teaching me how to take bigger swallows. I have since been better able to do the same large swallows with water again.
Dry mouth: This was actually with both phases from the pain and nausea meds. It is a really odd thing to feel the need to swallow and to be unable to do so. It is a mild panicky sensation. If I wet my mouth, then I can swallow and then I feel better.
Thankfulness: I really value and appreciate my treatment team. Their kindness and interactions with me are important to me. I enjoy getting to know them and who they are. Their kindness and understanding make things a lot better. The arm that they offer me to help me off of the radiation table is oddly such a real comfort and support. I find myself wanting to give back to them.

So what have I learned?

I don’t envy Brenda anymore. The grass does indeed always seem greener, but it is not. I would prefer to be up and moving around rather than the one in the bed. Appreciate what you have. Be content with what you have and enjoy it in the moment rather than wishing for what others have.
When you get the time to do all the things that you were wanting to do, you might not have the energy or desire to do them. Life can play cruel tricks on you sometimes! Enjoy the good in your day today rather than wishing it away on tomorrow.
I better understand the struggles of my patients for whom I have prescribed a TON of medicines. I am even thinking about setting alarms for myself to remind me to take my pills. I am anxious that a pill box may be in my future! It is not easy coordinating and remembering to take every dose on time. I think I am capable of it but then yesterday morning I went out to breakfast with a friend and realized that I had forgotten to take my pills beforehand. Oops. (I took them an hour or so late instead!) Listen and problem solve with your patients. It is hard for even intelligent and motivated patients to be perfectly adherent. I now completely understand why we have a pharmacist in the advanced heart failure clinic!
I really appreciate the role of direct caregivers. The nurses and aides are so valuable. Health systems – pay attention to this – if you want good patient satisfaction scores – be sure to take care of them and make sure that you have good staff in these roles! Appreciate and value those who directly touch the patients. They are SO important.
A desire to give back: As a patient I want to contribute and show my thanks. Please let me do this. It is hard enough to be in the receiving role. It makes me feel good to ask how you are and to support you. Let your patients give as well as receive.
We were designed to be creative and to work. I think that is part of what is driving my energy for this blog so much. Mimi E I hope you don’t mind me calling out to you from this blog, but you are a great instructor for all of us in this. You were a great teacher as a physician and now you continue to be as a patient. To be human we all feel a need to create something. Mimi does an amazing job with her painting and photography. We were all meant to work. Feel the joy of it. When you are stretched feel it as a good thing, as a growing thing, and as an essential part of being human.

And so, as a conclusion to this posting I will quickly repeat my primary lessons:

Be content with what you have rather than envying others. It really is not that great being in the hospital bed or sitting at home watching, “Gunsmoke.”
Seek out and really enjoy the good that you have in today. Do not squander it wishing for tomorrow.
Partner and problem solve with your patients. This is the key to compliance / adherence.
Value the staff that directly interact with the patients.
Let your patients give back to you.
Enjoy the work that you have today. I know that there may be parts of it that are not fun but as humans we are meant to work. Like a good workout feel the stretch and pull and challenge and enjoy it.

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